Organization
OASIS THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEIDRA CORDOVA LCSW (CLINICAL SOCIAL WORKER)
(505) 617-1180
Entity
Organization
Contact information
Practice address
1520 NM-94, MORA, NM 87732
(505) 617-1180
Mailing address
PO BOX 1051, MORA, NM 87732-1051
(505) 617-1180
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04458532
—
NM
01
—
1851806525
NPI
—
Enumeration date
05/21/2021
Last updated
05/21/2021
About Stedi
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